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Combined-accelerated stress testing (C-AST) is developed to establish the durability of photovoltaic (PV) products, including for degradation modes that are not a priori known or examined in standardized tests. C-AST aims to comprehensively represent the sample, stress factors, and their combinations using levels at the statistical tails of the natural environment. Acceleration factors for relevant climate sequences within the C-AST cycle with respect to the Florida USA climate are estimated for selected degradation mechanisms. It is found that for degradation of the outer backsheet polymer layer, the acceleration factor of the tropical climate sequence (the longest of the climate sequences) is f (T, G) = 17.3 with ultraviolet photodegradation; for polyethylene terephthalate hydrolysis (backsheets), f (T, RH) = 426; for electrochemical corrosion (PV cell), f (I) = 14.1; and for PbSn solder fatigue f (ΔT, r (T)) = 17.3. Here, T is the module temperature, G is the broadband spectrum irradiance on the plane of array of the module, RH is the relative humidity on the module surface, I is the leakage current through the module packaging, and r(T), the number of temperature reversals. The methods discussed herein are generally applicable for evaluating acceleration factors in other accelerated test methods.

We report enantioselective one-carbon ring expansion of aziridines to make azetidines as a new-to-nature activity of engineered “carbene transferase” enzymes. A laboratory-evolved variant of cytochrome P450_(BM3), P411-AzetS, not only exerts unparalleled stereocontrol (99:1 er) over a [1,2]-Stevens rearrangement but also overrides the inherent reactivity of aziridinium ylides, cheletropic extrusion of olefins, to perform a [1,2]-Stevens rearrangement. By controlling the fate of the highly reactive aziridinium ylide intermediates, these evolvable biocatalysts promote a transformation which cannot currently be performed using other catalyst classes.

Biocatalysis, the application of enzymes to solve synthetic problems of human import, has blossomed into a powerful technology for chemical innovation. In the past decade, a threefold partnership, where nature provides blueprints for enzymatic catalysis, chemists introduce innovative activity modes with abiological substrates, and protein engineers develop new tools and algorithms to tune and improve enzymatic function, has unveiled the frontier of new-to-nature enzyme catalysis. In this perspective, we highlight examples of interdisciplinary studies which have helped to expand the scope of biocatalysis, including concepts of enzymatic versatility explored through the lens of biomimicry, to achieve both activities and selectivities that are not currently possible with chemocatalysis. We indicate how modern tools, such as directed evolution, computational protein design and machine learning-based protein engineering methods, have already impacted and will continue to influence enzyme engineering for new abiological transformations. A sustained collaborative effort across disciplines is anticipated to spur further advances in biocatalysis in the coming years.

National and international guidelines recommend the use of 1 dose of intravesical chemotherapy immediately following surgery for nonmuscle invasive bladder cancer, which is performed infrequently on a population level. We sought to understand the importance of potential environmental and clinical dimensions involved in the decision to offer this therapy.Urologists from the Michigan Urological Surgery Improvement Collaborative (MUSIC) rated 8 distinct clinical vignettes involving patients with nonmuscle invasive bladder cancer. A ratings-based conjoint analysis method was used to evaluate the clinical vignette responses. Each vignette included 4 clinical dimensions and 2 environmental dimensions, with each dimension consisting of 2 possible attributes. The relative importance of each attribute was derived from the regression model and ranked in order.A total of 58 urologists answered the clinical vignettes which represents75% of MUSIC sites. The median age of urologists was 53, most were male, and median years in practice was 20 years post residency. An environmental attribute, having a recovery room protocol for instilling and disposing of the chemotherapy, ranked as the most influential attribute for giving postoperative chemotherapy (utility=8.6). The clinical attribute yielding the strongest preference for giving chemotherapy was tumor grade (utility=4.9). These preferences varied by different subgroups of urologists, particularly regarding the type of practice a urologist was in.This study demonstrates that urologists have clear preferences for when they offer postoperative immediate chemotherapy. Factors beyond just clinical variables play a role in this decision making process such as the structure of the recovery room.

The viability of novel coextruded, fluoropolymer-free backsheets for photovoltaic (PV) modules has been questioned as a result of a large number of early-life backsheet failures in PV installations containing one of the earliest co-extruded polyamide (PA)-based backsheet to reach the market, “AAA.” New PV reliability testing protocols have been recently developed and applied to backsheets to reproduce failures observed in the field and evaluate the durability of novel backsheet materials and designs prior to commercialization. A new co-extruded PA-based backsheet was tested using combined-accelerated stress testing (C-AST) and demonstrated a greater lifetime than AAA, and some other fluoropolymer-based backsheets such as polyvinylidene fluoride. The improved PA-based backsheet also eventually failed by through-thickness cracking. Using surface and bulk material characterization techniques, we performed a comprehensive study of material properties before and after the stress testing. Aging of the backsheet resulted in an increase of surface roughness by erosion of the outer PA layer. However the failure is more likely related to an increase in crystallinity of the polyolefin core layer reducing the backsheet tearing energy. The analysis can ultimately inform on the specific weaknesses of the materials so that the manufacturer can improve the backsheet design to extend its lifetime.

Delamination between layers in photovoltaic (PV) backsheets is often reported in the literature, causing voids that can collect moisture, diminish module backside heat dissipation, and reduce the backsheet’s effectiveness as a physical barrier. While backsheets with weathering-resistant fluoropolymer outer layers have traditionally been used in modules, more recent backsheets using non-fluoropolymer outer layers, such as polyethylene terephthalate (PET), have been developed. These backsheets have shown signs of premature degradation, and their adhesion degradation, in particular, has not been widely studied. In the present work, the single cantilever beam (SCB) adhesion test was used to quantify the adhesion energy in two commercially available PET-based backsheets. To study the effect of minor changes in formulation, the backsheets were obtained from same manufacturer and product line but during different years. To study the effect of environmental variables on adhesion degradation, the backsheets were subjected to artificial weathering at controlled temperature, humidity, and ultraviolet (UV) radiation in an indoor weathering chamber, and the adhesion energy was quantified at several intervals of exposure time. Layering structure, composition, and adhesion failure mode were compared between the backsheets, using Raman and infrared spectroscopy and thermogravimetric analysis. The results show a large difference in initial (unexposed) adhesion energy between the backsheets, despite very similar structures and compositions. Following exposure, adhesion energy dropped significantly, primarily due to thermo-hydrolytic degradation of the polyurethane (PU)-based adhesive layers. Significant UV-induced adhesion degradation of the PET outer layer surface was also observed. The study represents an important step in understanding adhesion degradation in PET-based backsheets, suggesting ways in which adhesion integrity – and, correspondingly, module service life – can be improved.

Decipher Biopsy is a commercially available gene expression classifier used in risk stratification of newly diagnosed prostate cancer (PCa). Currently, there are no prospective data evaluating its clinical utility. We seek to assess the clinical utility of Decipher Biopsy in localized PCa patients. A multi-institutional study of 855 men who underwent Decipher Biopsy testing between February 2015 and October 2019. All patients were tracked through the prospective Michigan Urological Surgery Improvement Collaborative and linked to the Decipher Genomics Resource Information Database (GRID®; NCT02609269). Patient matching was performed by an independent third-party (ArborMetrix Inc.) using two or more unique identifiers. Cumulative incidence curves for time to treatment (TTT) and time to failure (TTF) were constructed using Kaplan–Meier estimates. Multivariable Cox proportional hazard models were used to evaluate the independent association of high-risk Decipher scores with the conversion from AS to radical therapy and treatment failure (biochemical failure or receipt of salvage therapy). Eight hundred fifty-five patients underwent Decipher Biopsy testing during the study period. Of the 855 men, 264 proceeded to AS (31%), and 454 (53%) received radical therapy. In men electing AS, after adjusting for NCCN risk group, age, PSA, prostate volume, body mass index, and percent positive cores, a high-risk Decipher score was independently associated with shorter TTT (HR 2.51, 95% CI 1.52–4.13 p

This study is focusing on leveraging the system design tools set for next-generation solid oxide fuel cell (SOFC) based natural gas fuel cell (NGFC) system. Conventionally, system design and optimization of NGFC systems rely heavily on traditional reduced order model (ROM) techniques and designers’ experience level. For overcoming the technical barriers of system design, multiple multi-physics models and machine learning (ML) tools have been utilized to automate the conceptual design process and enhance the reliability of solutions for the NGFC system. The proposed tools set includes a physics-informed ML tool for automated ROM construction that leverages advances in deep neural networks to significantly reduce ROM prediction error for the NGFC power island compared to traditional approaches. The constructed physics-informed ML ROM can be used in system design and optimization tools set Institute for the Design of Advanced Energy Systems (IDAES) Process Systems Engineering (PSE) framework. The tools set also provides user-friendly graphic user interface built within Jupyter Notebooks, and the whole tools set is open-source public available.

We used data-analytics approaches to develop, calibrate, and validate predictive models, to help urologists in a large statewide collaborative make prostate cancer staging decisions on the basis of individual patient risk factors. The models were validated using statistical methods based on bootstrapping and evaluation on out-of-sample data. These models were used to design guidelines that optimally weigh the benefits and harms of radiological imaging for the detection of metastatic prostate cancer. The Michigan Urological Surgery Improvement Collaborative, a statewide medical collaborative, implemented these guidelines, which were predicted to reduce unnecessary imaging by more than 40% and limit the percentage of patients with missed metastatic disease to be less than 1%. The effects of the guidelines were measured after implementation to confirm their impact on reducing unnecessary imaging across the state of Michigan.

Nanoindentation and fluorescence spectroscopy provide spatially resolved mechanical and chemical characterization for degradation of poly (ethylene-co-vinyl acetate) (EVA) encapsulants aged under accelerated weathering and in field deployed photovoltaic (PV) modules. For the accelerated weathering tests, two different EVA formulations in the glass/EVA/glass-laminated coupons were exposed to ultraviolet (UV) light for 180 days at three different temperatures (40, 60, and 80 °C) and UV intensities (0.4, 2.2, and 2.9 W/m2/nm at 340 nm). The fluorescence spectra and moduli were uniform through the cross section of both EVA formulations at the lowest temperature and UV intensity; however, under the highest temperature and UV intensity, the UV irradiated sides showed lower moduli and higher fluorescence compared to the opposite sides. For EVA obtained from PV modules deployed 27 years in Sacramento, CA, USA, changes in fluorescence intensity across the thickness were relatively greater than changes in modulus. On the other hand, for EVA obtained from the same type of module stored in the shed for 27 years, no fluorescence was observed, and a uniform modulus was seen through the EVA layer, but with substantially higher values than those obtained from the field-deployed modules. The different extent of changes between laboratory and field exposures suggests the importance of considering effects of temperature and UV intensity for designing a reliable accelerated testing. This study uniquely demonstrates the capability of microscale characterization using nanoindentation and fluorescence microscopy to monitor mechanical and chemical degradation of EVA encapsulants in PV modules.

Existing power plants are frequently load-following due to increasing penetration of the renewables into the grid. For power plants integrated with CO2 capture, optimal operation of the capture uni...

Myth Corticosteroid injection for the treatment of pain and inflammation is known to decrease the efficacy of the messenger ribonucleic acid (mRNA) vaccines for coronavirus disease 2019 (COVID-19). Fact There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an mRNA COVID-19 vaccine decreases the efficacy of the vaccine. However, based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Pfizer-BioNTech and Moderna vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than 2 weeks prior to a COVID-19 mRNA vaccine dose and no less than 1 week following a COVID-19 mRNA vaccine dose, whenever possible.

Objective To determine rates of watchful waiting (WW) vs treatment in prostate cancer (PCa) and limited life expectancy (LE) and assess determinants of management. Materials and Methods Patients diagnosed with PCa between 2012 and 2018 with Results Total 2393 patients were included. Overall, WW was performed in 8.1% compared to 23.3%, 25%, 11.2%, and 3.6% who underwent AS, radiation (XRT), prostatectomy (RP), and brachytherapy (BT), respectively. In men with NCCN low-risk disease (n = 358), WW was performed in 15.1%, compared to AS (69.3%), XRT (4.2%), RP (6.7%), and BT (2.5%). There was wide variation in management among practices in low-risk men; WW (6%-35%), AS (44%-81%), and definitive treatment (0%-30%). Older age was associated with less likelihood of undergoing AS vs WW (odds ratio [OR] 0.88, P Conclusion Wide practice level variation exists in management for patients with low- and favorable-risk PCa and

Previously undiscovered failure modes in photovoltaic (PV) modules continue to emerge in field installations despite passing protocols for design qualification and quality assurance. Failure to detect these modes prior to widespread use could be attributed to the limitations of present-day standard accelerated stress tests (ASTs), which are primarily designed to identify known degradation or failure modes at the time of development by applying simultaneous or sequential stress factors (usually two at most). Here, we introduce an accelerated testing method known as the combined-accelerated stress test (C-AST), which simultaneously combines multiple stress factors of the natural environment. Simultaneous combination of multiple stress factors allows for improved identification of failure modes with better ability to detect modes not known a priori. A demonstration experiment was conducted that reproduced the field-observed cracking of polyamide- (PA-) and polyvinylidene fluoride (PVDF)–based backsheet films, a failure mode that was not detected by current design qualification and quality assurance testing requirements. In this work, a two-phase testing protocol was implemented. The first cycle (“Tropical”) is a predominantly high-humidity and high-temperature test designed to replicate harsh tropical climates. The second cycle (“Multi-season”) was designed to replicate drier and more temperate conditions found in continental or desert climates. Testing was conducted on 2 × 2-cell crystalline-silicon cell miniature modules constructed with both ultraviolet (UV)–transmitting and UV-blocking encapsulants. Cracking failures were observed within a cumulative 120 days of the Tropical condition for one of the PA-based backsheets and after 84 days of Tropical cycle followed by 42 days of the Multi-season cycle for the PVDF-based backsheet, which are both consistent with failures seen in fielded modules. In addition to backsheet cracking, degradation modes were observed including solder/interconnect fatigue, various light-induced degradation modes, backsheet delamination, discoloration, corrosion, and cell cracking. The ability to simultaneously apply multiple stress factors may allow many of the test sequences within the standardized design qualification procedure to be performed using a single test setup.

Colorectal cancer screening has been shown to prevent or detect early colorectal cancer and reduce mortality; yet, adherence to screening recommendations remains low, particularly in rural settings.RCT.Adults (n=7,812) aged 50-75 years and due for colorectal cancer screening in a largely rural health system were randomly assigned to either the intervention (n=3,906) or the control (n=3,906) group in September 2016, with analysis following through 2018.A mailed motivational messaging screening reminder letter with an option to call and request a free at-home fecal immunochemical screening test (intervention) or the standard invitation letter detailing that the individual was due for screening (control). Multifaceted motivational messaging emphasized colorectal cancer preventability and the ease and affordability of screening, and communicated a limited supply of test kits.Colorectal cancer screening participation within 6 months after mailed invitation was ascertained from the electronic medical record.Colorectal cancer screening participation was significantly improved in the intervention (30.1%) vs the usual care control group (22.5%; p0.001). Individuals randomized to the intervention group had 49% higher odds of being screened over follow-up than those randomized to the control group (OR=1.49, 95% CI=1.34, 1.65). A total of 13.2 screening invitations were needed to accomplish 1 additional screening over the usual care. Of the 233 fecal immunochemical test kits mailed to participants, 154 (66.1%) were returned, and 18 (11.7%) tested positive.A mailed motivational messaging letter with a low-cost screening alternative increased colorectal cancer screening in this largely rural community with generally poor adherence to screening recommendations. Mailed colorectal cancer screening reminders using motivational messaging may be an effective method for increasing screening and reducing rural colorectal cancer disparities.

PURPOSE: To determine whether the type of delivery system is associated with intensity of care at the end of life for Medicare beneficiaries with cancer. PATIENTS AND METHODS: We used SEER registry data linked with Medicare claims to evaluate intensity of end-of-life care for patients who died of one of ten common cancers diagnosed from 2009 through 2014. Patients were categorized as receiving the majority of their care in an integrated delivery system, designated cancer center, health system that was both integrated and a certified cancer center, or health system that was neither. We evaluated adherence to seven nationally endorsed end-of-life quality measures using generalized linear models across four delivery system types. RESULTS: Among 100,549 beneficiaries who died of cancer during the study interval, we identified only modest differences in intensity of end-of-life care across delivery system structures. Health systems with no cancer center or integrated affiliation demonstrated higher proportions of patients with multiple hospitalizations in the last 30 days of life (11.3%), death in an acute care setting (25.9%), and lack of hospice use in the last year of life (31.6%; all P < .001). Patients enrolled in hospice had lower intensity care across multiple end-of-life quality measures. CONCLUSION: Intensity of care at the end of life for patients with cancer was higher at delivery systems with no integration or cancer focus. Maximal supportive care delivered through hospice may be one avenue to reduce high-intensity care at the end of life and may impact quality of care for patients dying from cancer.

Objective: In the schematic design phase of a new freestanding children’s hospital, Simulation-based Hospital Design Testing (SbHDT) was used to evaluate the proposed design of 11 clinical areas. The purpose of this article is to describe the SbHDT process and how it can help identify and mitigate safety concerns during the facility design process. Background: In the design of new healthcare facilities, the ability to mitigate risk in the preconstruction period is imperative. SbHDT in a full-scale cardboard mock-up can be used to proactively test the complex interface between people and the built environment. Method: This study was a prospective investigation of SbHDT in the schematic design planning phase for a 400-bed freestanding children’s hospital where frontline staff simulated episodes of care. Latent conditions related to design were identified through structured debriefing. Failure mode and effect analysis was used to categorize and prioritize simulation findings and was used by the architect team to inform design solutions. A second round of testing was conducted in order to validate design changes. Results: A statistically significant reduction in criticality scores between Round 1 ( n = 201, median = 16.14, SD = 5.8) and Round 2 ( n = 201, median score of 7.68, SD = 5.26, p < .001) was identified. Bivariate analysis also demonstrated a statistically significant reduction in very high/high criticality scores between Round 1 and Round 2. Conclusions: SbHDT in the schematic phase of design planning was effective in mitigating risk related to design prototypes through effective identification of latent conditions and validation of design changes.

Several guidelines recommend pelvic lymph node dissection (PLND) at robot-assisted radical prostatectomy (RARP) only when lymph node involvement (LN+) is2%. Individual surgeon use of PLND is not well-known. We sought to examine variability in PLND performance and detection of LN+ across the Michigan Urological Surgery Improvement Collaborative.Data regarding all RARP (3/2012-9/2018) were prospectively collected, including patient and surgeon characteristics. Univariable and multivariable analyses of PLND rate and LN+ rate were performed.Among 9,751 men undergoing RARP, 79.8% had PLND performed (n = 7,781), of which 5.2% were LN+ (n = 404). In univariate and multivariable analyses, predictors of PLND included higher Prostate-Specific Antigen (PSA), biopsy Gleason grade (bGG), number of positive cores, and maximum core involvement at P0.05 for each. Higher PSA, cT stage, bGG, number of positive cores, and maximum core involvement predicted LN+ when PLND was performed (P0.05 for each). There was significant surgeon variation in the proportion of PLND performed at RARP, yet neither surgeon-annualized RARP volume nor % of PLND performed was associated with LN+ disease (P0.05). Grade was associated with PLND (60.0%, 77.6%, 91.0%, 97.3%, and 98.5%; P0.001) and LN+ (0.7%, 2.5%, 5.8%, 8.6%, and 19.9%; P0.001) for bGG 1,2,3,4,5, respectively. Maximum core involvement also strongly predicted LN+ with rates of 1.5%, 3.8%, and 9.4% for35%, 35% to 65%, and65%, respectively (P0.001).Nearly 80% of RARP in Michigan Urological Surgery Improvement Collaborative were performed with PLND, including 60% of bGG1 patients (with LN+ in only 0.7%), but significant variability exists between surgeons. Our data indicate limited benefit for favorable-risk CaP patients and support efforts to decrease PLND use going forward.

Dew accelerates the soiling rates and increases the dust adhesion. To use dew for self-cleaning, a fluorinated ethylene propylene coating was applied to suppress the reactions between dust and glass as well as to facilitate the dew to condense as mobile droplets. An array of rectangular hydrophilic channels in the coating increases the condensation rates and droplet slide-off diameters. The durability of the coating was evaluated by artificial UV weathering. Four different types of soilants were used in the artificial soiling tests to assess the effect of soilant type and surface properties on the soiling rates and self-cleaning efficacy under the simulated dew conditions. Soil deposition and self-cleaning mechanisms are being reported.

High-flow nasal oxygen systems are rapidly being adopted as an initial noninvasive treatment for acute respiratory failure. However, the term “high-flow nasal cannula” is nonspecific and leads to imprecise communication between physicians, respiratory therapists, and nurses with the potential for patient harm. In this viewpoint and a brief review of the technology, we argue for a change in nomenclature in order to reduce the chance for future clinical, administrative, and research misunderstanding surrounding high-flow nasal oxygen systems.

Natural soiling and the subsequent requisite cleaning of photovoltaic (PV) modules result in abrasion damage to the cover glass. The durability of the front glass has important economic consequences, including determining the use of antireflective and/or antisoiling coatings as well as the method and frequency of operational maintenance (cleaning). The abrasion of coatings and glass has been explored in a field study, including the soiling-prone locations of Dubai (United Arab Emirates), Kuwait City (Kuwait), Mesa (Arizona), Mumbai (India), and Sacramento (California). Dry-brush-cleaned specimens will be compared with those subjected to artificial-brush testing. The characteristics of material integrity, surface energy, optical transmittance, surface roughness, and scratch size were examined using an optical microscope, contact goniometer (for water), spectrophotometer, interferometer, and atomic force microscope, respectively. The findings of this article will be used to provide feedback regarding the cleaning equipment, cleaning methods, and coatings used in the PV industry. The study here will also be used to aid in developing an abrasion standard for the PV industry.

Novel materials are being enabled by advances in synthesis techniques that achieve ever better control over the atomic-scale structure of materials. The pace of materials development has been further increased by high-throughput computational experiments guided by informatics and machine learning. We have previously demonstrated complementary approaches using mathematical optimization models to search through highly combinatorial design spaces of atomic arrangements, guiding the design of nanostructured materials. In this paper, we highlight the common features of materials optimization problems that can be efficiently modeled via mixed-integer linear optimization models. To take advantage of these commonalities, we have created